CARDIAC ANATOMY AND

PHYSIOLOGY
Dr Rheecha Joshi
• 045 % of body weight
• Base and apex
• Surfaces: sternocostal/ anterior
:diaphragmatic/ inferior
:left and right/ pulmonary surfaces
• Borders: Upper
: Acute margin
: Obtuse margin
RIGHT ATRIUM
• receives systemic venous drainage from inferior and superior venae cavae,
coronary venous drainage from the coronary sinus
• presence of the limbus of the fossa ovalis and the fossa ovalis (septum primum)
• wide-based, blunt ended, right-sided atrial appendage (auricle);

• Eustachian valve at the orifice of the inferior vena cava and Thebesian valve at
the orifice of the coronary sinus

• crista terminalis, which separates trabeculated from nontrabeculated (venous)

portions of the atrium
Triangle of Koch
• Between septal leaflet of TV ,anteromedial margin of coronary sinus
and tendon of Todaro

• Indicate the site of AV node

LEFT ATRIUM
• receives pulmonary venous drainage from the four pulmonary veins

• septal surface is characterized by the flap valve of the fossa ovalis

• The left atrial appendage (auricle) is long and narrow

• no crista terminalis at the base of the left atrial appendage

Right Ventricle
• coarsely trabeculated

• Anterosuperior, inferior, left and posterior or septal surface

• Internally , has a large sinus portion that surrounds and supports a

tricuspid atrioventricular (AV) valve (inlet portion) and

• a smaller infundibulum (outlet portion) that supports a semilunar

valve
Left ventricle
• Forms sternocostal, left and inferior cardiac surface
• Internally consists of a larger sinus portion, which supports a bicuspid AV
valve and includes the apex,
• smaller outlet (outflow) portion beneath a semilunar valve.
• inflow and outflow portions are separated by the anterior mitral leaflet
• Passsageway below aortic valve , bounded by outflow portion of
ventricular septum and anterior leaflet of mitral valve is called left
ventricular outflow tract.
• the anterior mitral leaflet is in fibrous continuity with the aortic valve in
an area termed the aortic–mitral anulus
Atrioventricular valves
• Maintain unidirectional blood flow

• Electrical separate atria and ventricles

• Each valve has

 Valvular apparatus: annulus, leaflets, commissures
Tensor apparatus: chordae tendineae, papillary muscles
• Commissure is site along a valve annulus where two leaflets meet

• Always have an underlying papillary muscles and fan like array of

tandinous cords that attach to both leaflets
• If tendinous cords are malformed, weakened,or
• insufficient in number , a portion of leaflet can
bulge and
• prolapse leading to valvular regurgitation
• Papillary muscle ischemia or ventricular dilation
produce valvular regurgitation

• Severe birth asphyxia (TR)

• Persistent pulmonary hypertension of the newborn

Mitral valve
• Bicuspid , is typically 4–6 cm² in area with diameter of 3.1 ± 0.4 cm, and the
circumference is 8 to 9 cm

• Annulus is circular in diastole , ellipitical during systole

• Annuluar circumference and area decrease by 15% and 25 % during ventricular systole

• anterior ( aortic or septal) leaflet and a posterior ( mural or ventricular) leaflet

• The larger anterior (septal, aortic, anteromedial) leaflet is roughly triangular in shape,
with the base of the triangle inserting on about one third of the anulus. It has a relatively
smooth free margin with few or no indentations.
• The smaller posterior (mural, ventricular, posterolateral) leaflet inserts into about
two thirds of the anulus and typically has a scalloped appearance

• two large papillary muscles of the left ventricle: anterolateral and posteromedial,
both arising from ventricular free wall

• Each leaflet receives chordae from both papillary muscles

• Anterolateral papillary muscle usually has dual blood supply from LAD and CCA

• Posteromedial papillary muscle is supplied by RCA

Tricuspid valve
• Annulus is shaped like reversed D when viewed from ventricular aspect , orifice is roughly
triangular and larger than the mitral orifice

• The normal valve area in adults is 4-6 cm2

• The leaflets and chordae tendineae are thinner than those of the mitral valve

• annulus is a very dynamic structure, there is approximately 19% of reduction in annular

circumference with atrial systole

• Normal tricuspid valve diameter in adults is 28 ± 5 mm, as measured in the apical 4-chamber
view
• The valve consists of three leaflets : anterior, posterior and septal

• Since the valve is nearly vertical (approximately 45 degrees to the sagittal plane), the
anterior leaflet is also referred to as superior, while the posterior leaflet has also
been called inferior.

• The anterior leaflet (also called anterosuperior and infundibular) is the largest
leaflet; the septal leaflet (also medial) is usually the second largest leaflet, while the
posterior leaflet (also called inferior and marginal) is most frequently the smallest of
the three

• The posterior leaflet often has multiple scallops

• 3 papillary muscle : anterior , posterior, medial
• Anterior papillary muscle originate from acute margin of RV , provide cordal
insertion to anterior and posterior leaflets
• Posterior papillary muscle arises from inferior wall near the septum , cordal
insertion to posterior and septal leaflets
• Medial papillary muscle/ papillary muscle of conus /muscle of Lancisi arises
from superior aspect of the septal band at the level of membranous septum ,
cordal attachment to septal and anterior leaflets
• The anterior and septal papillary muscles are connected by the moderator
band / the septomarginal trabecula carrying the part of the right bundle of
the conduction system to the anterior papillary muscle
• major surgical importance is proximity of the conduction system to
the septal leaflet and its anteroseptal commissure

• The membranous septum usually lies beneath the septal leaflet

inferior to the anteroseptal commissure

• The bundle of His lies beneath the interventricular component of the

membranous septum (usually about 5 mm inferior to the
commissure) and runs along the crest of the muscular septum
Semilunar valves
• shape of triradiate crown
• Consists of an annulus ,cusps and commissures
• No tensor apparatus
• Their opening and closure are primarily passive processes
• Cusps contain elastic tissue and have little elastic recoil
• During isovolumetric ventricular contraction , expansion of the arterial
root may produce commissural separation and initiate valvular opening
• As retrograde blood flow fills each valve pockets during ventricular
diastole , valvular closure occurs
Aortic valve
• aortic annulus is midline structure and orifice is directed toward right
shoulder
• is normally tricuspid and composed of delicate cusps and sinuses of
Valsalva.
• the valve is in fibrous continuity with the anterior leaflet of the mitral
valve and the membranous septum
• The aortic sinuses (sinuses of Valsalva) are dilated pockets of the aortic
root - The coronary arteries arise from two of these aortic sinuses
• The sinus and cusp without an associated coronary artery are termed
noncoronary
Pulmonary valve
• closest to chest wall, orifice is directed toward left shoulder
• has three cusps, with a nodule at the midpoint of each free edge, and
lunulae and thin, crescent-shaped coaptive surfaces on both sides of
the nodules.
• The pulmonary valve is lifted away from the ventricular septum by the
subpulmonary infundibulum
• The first septal branch of the left anterior descending coronary
artery pierces the ventricular septum below subpulmonary
infundibulum
CORONARY ARTERIES
• From the standpoint of the surgeon, the coronary artery system is
divided into four parts:
• the left main coronary artery,
• the left anterior descending coronary artery and its branches,
• the left circumflex coronary artery and its branches,
• the right coronary artery and its branches
• Variability in the origin of the posterior descending artery is expressed
by the term dominance

• A right dominant coronary circulation is one in which the posterior

descending coronary artery is a terminal branch of the right coronary
artery

• A left dominant circulation, which occurs in about 10% to 15% of

hearts, is one in which the posterior descending coronary artery is a
branch of the left circumflex coronary artery
Left Circumflex Coronary Artery
• originates from the left main coronary artery at about a 90-degree
angle
• The sinus node artery occasionally originates from the first few
millimeters of the left circumflex artery.
• A large branch originating from the proximal left circumflex artery and
coursing around the left atrium near the AV groove is termed the
atrial circumflex artery.
• The ventricular branches of the circumflex artery, the obtuse marginal
arteries, supply the obtuse margin of the heart
Right Coronary Artery
• is usually a single large artery and courses down the right AV groove.
• Right ventricular branches
• the anterior right atrial artery , and this branch often gives origin to
the sinus node artery.
• lateral right atrial artery (this artery is frequently severed when an
oblique right atriotomy is made)
• the acute marginal artery, which courses most of the way to the apex
of the heart
Cardiac veins
• Coronary sinus

• Anterior cardiac vein/ drain anterior part of right ventricle

• Thebesius vein/venous cordis minimae

Coronary sinus
• 2 or 3 cm long lying posterior in coronary sulcus

• Opens into right atrium , between opening of IVC and right AV orifice
,guarded by semilunar valve of coronary sinus

• Tributaries are
Great, small and middle cardiac vein , posterior vein of left
ventricle and oblique vein of left atrim
THANK YOU….
References
• Kirklin and Barratt- Boyes Cardiac Surgery

• Gray’s anatomy : the anatomical basis of medicine and surgery

• Moss And Adam’s Heart disease